8/17/2017. Turning Star Ratings to Gold

Transcription

1 Turning Star Ratings to Gold 1

2 Deer Meadows Home Health & Support Services, LLC. (DMHHSS) Stanley A. Rynkiewicz III, Administrator Irene E. Dudley, Clinical Director Judy M. Zdunkiewicz, Director of Finance Company History Deer Meadows Home Health & Support Services, LLC. (DMHHSS) Our Focus Our patients Our outcomes with quality care And business growth outreach to fully service all 5 counties where we are licensed 2

3 Home Health Compare Star Ratings Publically introduced by CMS Home Health Compare in July of 2015 At the time of inception, there were 12,261 Home Health Care Agencies and only 239 earned the Five-Star rating in the first quarter. Ratings are announce on a quarterly basis. The rating system was developed to provide consumers with tools that will help them make the best health care decisions possible. Currently.. Two Types of Star Ratings Quality of Patient Care Star Rating This is based on OASIS assessments and Medicare Claims data Patient Survey Star Rating (HHCAHPS) This is based on patient s experience of care measures 3

4 Quality of Patient Care Star Rating Calculation The methodology for calculating the Quality of Patient Care Star Rating is based on a combination of individual measure rankings and the statistical significance of the difference between the performance of an individual HHA on each measure (risk-adjusted, if an outcome measure) and the performance of all HHAs. Each HHA s quality measure scores are compared to the national agency median, and its rating is adjusted to reflect the differences relative to other agencies quality measure scores. These adjusted ratings are then combined into one overall rating that summarizes agency performance across 9 individual measures Measures that Determine the Star Rating Process Measures Timely initiation of care Strive for SOC w/ in hours. (always 24 hours from D/C of inpatient facility SNF or hospital) Medication education provided to patients and care givers Influenza immunization for current flu season Encourage Educate Administer 4

5 Measures that Determine the Star Rating Outcome Measures Improvement in ambulation Improvement in bed transferring Improvement in bathing Improvement in pain interfering with activity Improvement in shortness of breath Acute care hospitalization Home Health Care (CAHPS) Surveys Established in 2009 Designed to measure the experiences of people receiving home health care from Medicare-certified home health care agencies. This survey was developed to meet the following goals: To produce comparable data on the patient s perspective that allows objective and meaningful comparisons between home health agencies and consumers. Public reporting of survey results will create incentives for agencies to improve their quality of care. Public reporting will enhance public accountability in the health care by increasing the transparency of the quality of care provided in return for public investment. 5

6 The OASIS OASIS stands for Outcome and Assessment Information Set CMS views OASIS as a core standard assessment set that: Is integrated into an agency s comprehensive patientspecific assessment. Provides for valid, reliable information for patient care planning and service delivery. Is an important tool used in an effective quality assessment and improvement program. Must be collected at least twice on every patient to provide for accurate measurement of quality data. The OASIS Completing the OASIS comprehensive assessment correctly is Essential to patient outcomes Vital to agency financial impact Case study 6

7 Critical OASIS Moments Since 2007 HHQRP OASIS-C2 OASIS-C VBP OASIS-C1 IMPACT Act 5 Star Ratings ICD-10 Home Health Resource Group What is the HHRG? Based on 3 dimensions or domains: C = Clinical dimension F = Functional dimension S = Service (Therapy Visits) Both clinical and functional dimensions are divided into 3 levels of severity: C1, C2, C3 F1, F2, F3 Service (S) scoring is based on number and timing of therapy visits, not severity. 7

8 The Cost of Care Focus is on the patient Outcomes with quality of care Not over utilizing visits Maintaining a positive cost/care ratio Financial Case Study 78 year old patient admitted with problems controlling her HTN. Recently experienced an exacerbation of COPD. She is SOB when walking < 20 feet. States she has given up sewing quilts because of pain in her hands due to arthritis. Needs assistance dressing the lower body. She bathes independently in the shower using assistive devices to get in and out. She uses a raised toilet seat and grab bars to get on and off the toilet. She transfers from the side of the bed to a chair using a device and ambulates using a walker. Calculate the patient s HHRG score and payment. 8

9 Case Study Response CM Points M1021 I10, HTN 0 M1023 J44.9, COPD w/ exac 0 M1242 Pain interfering w/activity = 2 0 M1820 Lower Body Dressing = 1 1 M1830 Bathing = 1 0 M1840 Toileting = 1 0 M1850 Transferring = 1 0 M1860 Ambulation = 2 7 M2200 Therapy Use 0 Clinical Points (ICD 10 CM and OASIS) 0 Functional Points 8 HHRG Score C1F1S1 Case Weight Early Episode Low Therapy Reimbursement for C1F1S1 $1, Think of the Possibilities M1242 (Pain Interfering): This patient had stopped an activity (sewing) because of pain in her hands. Should the assessing clinician consider Response 3 on M1242? If she was having pain at least daily, Response 3 is appropriate. M1830 (Bathing): Patient is SOB walking < 20 feet. Is she safe bathing in the shower without at least stand-by assist (Response 2)? 9

10 Case Study Response CM Points M1021 I10, HTN 0 M1023 J44.9, COPD w/ exac 0 M1242 Pain interfering w/activity = 3 3 M1820 Lower Body Dressing = 1 1 M1830 Bathing = 2 6 M1840 Toileting = 0 0 M1850 Transferring = 1 0 M1860 Ambulation = 2 7 M2200 Therapy Use 0 Clinical Points (ICD 10 CM and OASIS) 0 Functional Points 14 HHRG Score C2F2S1 Case Weight Early Episode Low Therapy Reimbursement for C1F2S1 $2, Financial Impact C1F1S1 (0.5857) = $1, C2F2S1 (0.7232) = $2, $2, $1, = $ episodes X $ = $20, episodes X $ = $41, episodes X $ = $82,262 10

11 What if The same patient (C1F1) is receiving: a. 5 therapy visits in an early episode (C1F1S1) b. 15 therapy visits in an early episode (C1F1S1) c. 10 therapy visits in a late episode (C1F1S4) Answer: a. No change in payment for 5 or fewer therapy visits b = $3, c = $2, In Summary Case mix diagnoses Clinical case mix points Other case mix items Clinical case mix points Total of all CM diagnosis and clinical CM points C score Functional case mix items Functional case mix points Total functional CM points F Score Total number of therapy (service visits) S score C+ F+ S = HHRG (HHRG from OASIS converted to HIPPS* score for billing purposes) HIPPS score on the claim = Payment ($$$$) * Health Insurance Prospective Payment System score 11

12 DMHHSS Our Journey to the Stars We embodied our Philosophy, Mission, Vision and Focus Our Philosophy Our Mission To provide superior quality home health services that optimize the persons served ability to maximize their independence, health and wellness in their home. Our Vision To optimize the quality of life for all persons served by being the employer and provider of choice in delivering cost effective home health care and services Our Core Values Help Guide Our Actions Clinical Excellence Compassion Dignity Individualized, Personal Centered Care Quality Respect DMHHSS Our Journey to the Stars Our Focus From the beginning and remains Our patients Our outcomes with quality care And business growth outreach to fully service all 5 counties where we are licensed 12

13 What Enables DMHHSS to Remain Five Stars Holistic Approach to Patient Care Viewing each patient as a member of the community Treating each patient as if they were a member of our family Team Staff continued commitment to our Mission, Vision and Focus. Low Staff Turnover Education and Credentialing opportunities Increasing staff when necessary in order to provide quality patient care that supporting the cost/care ratio Inter-disciplinary Communication Essential to agency success What Enables DMHHSS to Remain Five Stars Technology Staying Current with the technological advances and opportunities within the healthcare industry. Accreditations CHAP Community Health Accreditation Partner Compliance and business operations Integration and maintenance Affiliations 13

14 What Enables DMHHSS to Remain Five Stars Understanding that the OASIS and HHRG impacts every member of the agency Administrator CFO/ Business office Clinical Director OASIS Coding Manager Clinical Staff (RN/ LPN/ PT/ OT/ ST) Certified Scheduler Office Support Staff What Enables DMHHSS to Remain Five Stars Marketing Media Placements Radio TV Social Media/ Internet/ Website Branding Staff Personal Contact Sales Leads and Qualifying lead sources In-service and educational information sessions Community awareness and events 14

15 What Does Success Look Like? 15

16 What Does Success Look Like? Staying abreast of ongoing changes in healthcare industry, including legislation Developing and implementing strategic business growth plans Quality Assurance & Performance Improvement (QAPI) Budgeting -- Forecasting Cash Flow Billing meetings Reviewing receivables Maintaining collectability Reviewing opportunities Agency Self Assessment There are no secrets to success. It is the result of preparation, hard work, and learning from failure. Colin Powell 16

17 Questions and Answers Resources Centers for Medicare and Medicaid Services (CMS) Ann Rambusch, MSN, HCS-O, RN Deer Meadows Home Health & Support Services, LLC. 17